27th February 2024

A 85 year old man is admitted to hospital with 4 hours of worsening breathlessness, wheeze and productive cough.

A 85 year old man is admitted to hospital with 4 hours of worsening breathlessness, wheeze and productive cough. On examination of his chest, there is reduced air entry bilaterally and widespread wheeze noted. His observations are as follows: HR 110, BP 98/85, RR 27 and sats 93% on RA. He is a long-term smoker and a retired joiner. He also has difficulty swallowing. His family reports that he has frequent admissions to hospital for similar episodes.
He is started on high flow oxygen, salbutamol and ipratropium nebuliser and a CXR is obtained. He continues however to be wheezy and short of breath. The nursing staff have reported concerns regarding the safety of his swallow.

What should be the next step in management?